During admission to the psychiatric unit, a female client is extremely anxious and states that she is worried about the sun coming up the next day. What intervention is most important for the RN to implement during the admission process?

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Mental Health HESI Quizlet Questions

Question 1 of 5

During admission to the psychiatric unit, a female client is extremely anxious and states that she is worried about the sun coming up the next day. What intervention is most important for the RN to implement during the admission process?

Correct Answer: B

Rationale: During admission to a psychiatric unit, it is crucial for the registered nurse to remain calm and use a matter-of-fact approach when addressing a client who is extremely anxious. By staying composed and adopting a matter-of-fact demeanor, the nurse can help establish trust and promote a sense of calm in the client. This approach can also convey a sense of reassurance and stability, which can be beneficial in managing the client's anxiety. Assisting the client in developing alternative coping skills (Choice A) may be important in the long term but is not the most immediate priority during the admission process. Asking the client why she is anxious (Choice C) may not be helpful at this moment as the client may not be able to articulate the specific reasons due to her heightened anxiety. Administering a PRN sedative (Choice D) should not be the initial intervention as it does not address the underlying cause of the anxiety and should be considered only if other non-pharmacological interventions are ineffective.

Question 2 of 5

A young adult female visits the mental health clinic complaining of diarrhea, headache, and muscle aches. She is afebrile, denies chills, and all laboratory findings are within normal limits. During the physical assessment, the client tells the RN that her sister thinks she is neurotic and calls her a hypochondriac. Which response is best for the RN to provide?

Correct Answer: B

Rationale: In this scenario, option B is the best response for the RN to provide. This response acknowledges and validates the client's feelings by showing empathy and understanding towards the impact of her sister's comments. It also demonstrates active listening and therapeutic communication skills. By stating, "I can hear that your sister's comments are overwhelming you," the RN addresses the client's emotional distress, opens up a conversation about the client's feelings, and provides an opportunity for further exploration. Option A is incorrect because it dismisses the client's concerns and feelings, which can be detrimental to the therapeutic relationship. It does not address the underlying emotional distress the client is experiencing due to her sister's comments. Option C is wrong because it suggests a judgmental approach by directly asking the client if she thinks she might be a hypochondriac. This response can lead to defensiveness and hinder open communication. Option D is not the best response as it deflects from the client's current emotional distress caused by her sister's comments. While exploring other stressors in the client's life is important, addressing the immediate issue of the client feeling overwhelmed by her sister's comments should take precedence in this situation. In an educational context, this question highlights the importance of therapeutic communication skills in mental health nursing. Nurses need to be empathetic, non-judgmental, and actively listen to clients to establish trust and provide effective care. Understanding the impact of social relationships on mental health is crucial for nurses to address holistic care needs of clients.

Question 3 of 5

The RN on the evening shift receives a report that a client is scheduled for electroconvulsive treatment (ECT) in the morning. Which intervention should the RN implement the evening before the scheduled ECT?

Correct Answer: B

Rationale: Keeping the client NPO after midnight is the appropriate intervention before ECT to prevent complications during the procedure. Withholding food and fluids reduces the risk of aspiration and helps ensure the safety of the client. Option A (Hold all bedtime medications) is incorrect because medications may need to be given as prescribed unless specified otherwise by the healthcare provider. Option C (Implement elopement precautions) is unrelated to preparing a client for ECT and focuses on preventing a client from leaving the treatment area. Option D (Give the client an enema at bedtime) is unnecessary and not a standard pre-ECT preparation, making it an incorrect choice.

Question 4 of 5

A middle-aged adult with major depressive disorder suffers from psychomotor retardation, hypersomnia, and lack of motivation. Which intervention is likely to be most effective in returning this client to a normal level of functioning?

Correct Answer: B

Rationale: Teaching the client to develop a plan for daily structured activities is the most effective intervention in this scenario. This intervention helps address psychomotor retardation and enhances motivation and functioning. By structuring the client's day, it can provide a sense of purpose, routine, and accomplishment. Option A, providing education on methods to enhance sleep, may be helpful but does not directly address the client's overall functioning. Option C, suggesting the client develop a list of pleasurable activities, may provide temporary relief but may not address the core symptoms of major depressive disorder. Option D, encouraging the client to exercise, can be beneficial, but in this case, addressing the lack of structure and motivation through a daily plan is more appropriate.

Question 5 of 5

What is the most appropriate intervention by the RN to address a client with obsessive-compulsive disorder (OCD) who repeatedly checks to see if the door is locked and asks for reassurance?

Correct Answer: A

Rationale: Setting a specific limit on the checking behavior is the most appropriate intervention for a client with OCD who repeatedly checks the door and seeks reassurance. This approach helps the client gradually reduce the compulsive behavior, promotes independence, and supports progress in treatment. Choice B is not the most suitable intervention as it does not directly address the compulsive checking behavior. Choice C, providing consistent reassurance, may reinforce the compulsive behavior and hinder treatment progress. Choice D of ignoring the behavior does not actively assist the client in managing their symptoms and addressing the underlying disorder.

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